The pediatric kidney is sensitive to scarring as a consequence of urinary tract infections (UTIs). Prevention of renal scars is paramount, as the associated damage may lead to long-term health issues including chronic renal failure. UTIs afflict up to 17% of girls, account for 5% of febrile conditions treated in emergency departments and 2% of pediatric hospitalizations, culminating in over $8 billion in medical expenditures each year. UTI is one of the most common reasons for short duration antibiotic exposure for acute treatment and long-term prophylactic antibiotic therapies to prevent recurrent UTI during childhood. In addition to the rise in antibiotic resistant organisms causing UTI, there is accumulating evidence that antibiotic use during childhood increases the susceptibility for chronic health problems (e.g. asthma, obesity, gastrointestinal diseases). Therefore, UTIs represent a significant health concern, particularly for the pediatric population.
There are multiple factors that confound the diagnosis of UTI. Uropathogenic Escherichia coli (UPEC), the most common causative agent of UTIs, is a member of a bacterial species that includes strains that range from non-pathogenic commensals to hemorrhagic diarrheal strains. Foxman B., Nat Rev Urol. December; 7(12):653-660 (2010). Non-pathogenic strains of E. coli are normal constituents of the gastrointestinal microbiome that can easily contaminate urine samples during specimen collection. Current clinical diagnostics do not distinguish non-pathogenic from uropathogenic strains of E. coli making diagnosis problematic, particularly in pediatric patients where clean sample collection is difficult. The symptoms associated with UTI are often difficult for children to report and are non-specific. Clinical differentiation between cystitis and pyelonephritis requires a reliable historian, and has important implications for long-term consequences. Therefore, there is a critical need for novel point of service diagnostics to objectively diagnose UTI.